Proficiency Testing InterNET

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Proficiency Testing InterNET
Testing System
  
 

In order to have access to the PTNET, we need to have all the available information about yourself and the laboratory you work for.  Please, complete the following form.


* Required fields.

Laboratory Information
* CLIA Number:    
* License Number:
(Must enter the leading zeros ie: 00001)
 
* Pin:      
User Information
* First Name:  
Initial:
* Last Name:  
Mother's Maiden Name:
Title:
Home Phone:
Work Phone:
Mobile Phone:
* Primary E-mail:    
* Primary E-mail (Confirmation):    
Secondary E-mail:  
Secondary E-mail (Confirmation):  
* User Name:  
User Role:
* Password:  
  The Password must be between 8 and 16 characters.  Must contain at least one digit, one lower case, one upper case and one of this @#$%^&+= special characters.
 Ex: Example1$
* Password Confirmation:    
* Security Question:  
* Security Answer: